What About Illegal Abortions?

If abortion is outlawed, will thousands of women die in the "back alley"?

Page Summary:

Some justify abortion on the claim that if it is outlawed, women will abort anyway and may die in the process. There are three problems with this hypothesis. First, it doesn't address the ethics of abortion. Second, laws against abortion would deter most women from having one. Third, there is no evidence that illegal abortions are more dangerous than legal abortions.

The wire coat hanger has long been a prop of "choice" for those staging abortion-rights rallies or protests. You see them on signs and buttons or hanging around necks to symbolize the idea that women will die en masse if they ever lose the legal right to kill their unborn offspring. The first problem with this line of defense is the fact that it has nothing to do with the ethics of abortion. It makes no attempt to justify the act of abortion, it simply argues that if women can't abort legally, they'll abort illegally and die in the process. Those who make such an argument conveniently ignore the fact that abortion itself kills a living human being, not by accident but by design. It is nonsensical to argue that society must keep it safe and legal for one human being to kill another human being—especially when the one being killed is both innocent and defenseless.

The second problem with the coat hanger argument is that it assumes that the legality of abortion does not influence a woman's willingness to have an abortion. This is simply not true. External restrictions have a huge impact on abortion frequency. The Centers for Disease Control (CDC) tells us that "from 1970 through 1982, the reported number of legal abortions in the United States increased every year."1 If the legality of abortion didn't influence a woman's willingness to choose abortion, we wouldn't have seen such a massive increase in abortion frequency during the years following its legalization. More recently, the National Abortion Federation (NAF), which maintains that "women resort to induced abortion irrespective of legal restrictions,"2 provides more examples of how influenceable a woman's decision to abort actually is. Consider:

The abortion rate of non-metropolitan women is about half that of women who live in metropolitan counties.3

Studies have found that public funding of abortion makes services accessible to women who would otherwise carry unintended pregnancies to term.4

The abortion rate of women with Medicaid coverage is three times as high as that of other women.5

Mississippi's "two-trip" requirement, which was the first of its kind to be enforced, reduced the abortion rate for Mississippi residents by over 15% in the first 12 months.6

What does this data tell us? It indicates that women who live in close proximity to abortion facilities are twice as likely to have an abortion as women who don't; women who have their abortions publicly paid for are up to three times as likely to abort; and requiring women to make a second trip to the abortion clinic makes them 15% less likely to abort. In other words, a woman's decision to have an abortion is influenced by all sorts of variables. The more convenient it is for a woman to have an abortion, the more likely she is to have one. And vice versa. The significant inconvenience of having to break the law to procure an abortion would be deterrent enough for most women facing an unplanned pregnancy.

The third problem with the coat hanger argument is that it has no solid historical basis. The late Dr. Bernard Nathanson cofounded the National Abortion Rights Action League (NARAL) and helped legitimize the claim that 10,000 women were dying each year from illegal abortions prior to the passage of Roe vs Wade. Before his death, Dr. Nathanson admitted that the number was completely fabricated for PR purposes. He writes in his exposé Aborting America:

How many deaths were we talking about when abortion was illegal? In N.A.R.A.L., we generally emphasized the drama of the individual case, not the mass statistics, but when we spoke of the latter it was always "5,000 to 10,000 deaths a year." I confess that I knew the figures were totally false, and I suppose the others did too if they stopped to think of it. But in the "morality" of our revolution, it was a useful figure, widely accepted, so why go out of our way to correct it with honest statistics? The overriding concern was to get the laws eliminated, and anything within reason that had to be done was permissible.7

Dr. Christopher Tietze, then acting as the chief statistician for Planned Parenthood and the Centers for Disease Control, also addressed the exaggerated claim of 5,000 - 10,000 abortion related deaths per year. He wrote in a 1969 edition of Scientific America:

Some 30 years ago it was judged that such deaths (from illegal abortion) might number 5,000 to 10,000 per year, but this rate even if it was approximately correct at the time, cannot be anywhere near the true rate now. The total number of deaths from all causes among women of reproductive age in the U.S. is not more than about 50,000 per year. The National Center for Health Statistics listed 235 deaths from abortion in 1965. Total mortality from illegal abortions was undoubtedly larger than that figure, but in all likelihood it was under 1,000.8

In the year prior to Roe v. Wade (1972), the Centers for Disease Control reports that 39 women died from illegal abortion in the United States and 24 died from legal abortion.9 That is a far cry from 5,000-10,000. The National Abortion Federation maintains that "between 1970 and 1980, legal abortion in the USA is estimated to have prevented 1,500 pregnancy-related deaths."10 But even if those numbers are accurate, legal abortion killed roughly 15 million human beings during that same stretch of time. If you do the math, the number of women "saved" by legal abortion from 1970 to 1980 was 0.0001% of the total number of innocent human beings killed by legal abortion. And at least half of those killed were women.

Finally, the coat hanger argument ignores that the increased "safety" of abortion in modern times owes not to its legality, but to improved medical technology. Mary Calderon, former director of Planned Parenthood, estimated in a July 1960 article from the American Journal of Public Health that 90% of all illegal abortions were performed by licensed physicians in good standing. She writes the following:

Abortion is no longer a dangerous procedure. This applies not just to therapeutic abortions as performed in hospitals but also to so-called illegal abortions as done by physicians. In 1957 there were only 260 deaths in the whole country attributed to abortions of any kind. In New York City in 1921 there were 144 abortion deaths, In 1951 there were only 15; and , while the abortion death rate was going down so strikingly in that 30-year period, we know what happened to the population and the birth rate. Two corollary factors must be mentioned here: first, chemotherapy and antibiotics have come in, benefiting all surgical procedures as well as abortion. Second, and even more important, the conference estimated that 90 percent of all illegal abortions are presently being done by physicians. Call them what you will, abortionists or anything else, they are still physicians, trained as such; and many of them are in good standing in their communities. They must do a pretty good job if the death rate is as low as it is...abortion, whether therapeutic or illegal, is in the main no longer dangerous.11

The National Abortion Federation affirms Calderon's conclusions in their 2009 teaching text on abortion. They write:

Around the period of legalization in the USA, technological advances in the field of abortion care facilitated new models of abortion delivery. Specifically, development of the vacuum aspirator, cervical anesthesia methods, and the Karman cannula all improved the safety of abortion and permitted its provision in nonhospital settings.12

First-trimester aspiration abortion is one of the safest procedures provided for women of reproductive age. Its use in lieu of dilation and sharp curettage has reduced abortion-related morbidity worldwide.13

The US adoption of laminaria tents in the 1970s to dilate the cervix before uterine evacuation represented a landmark in abortion care, permitting safe D&E later in pregnancy.14

In some situations of formal illegality, women can still obtain safe abortions.15

Even in developing countries with restrictive abortion laws, increasing use of MVA and medical abortion methods has reduced abortion-related mortality.16

Induced abortion is an impressively safe procedure, particularly but not exclusively where it is legal.107

Practitioners with MVA skills can treat most medical abortion complications privately in their own clinics, which is highly desirable in restrictive and remote practice settings.18

Medical abortion can expand access to safe abortion care, especially in restrictive or low-resource settings that lack other safe options… Using medications to induce abortion can lower costs and transfer control from the clinician to the woman. Empowering women may be particularly important where large social gaps exist between patients and clinicians, as is often the case in low-resource settings and where abortion is legally restricted and socially stigmatized.19

That misoprostol can be administered either in the clinic or in a different location of the woman's choosing enhances her ability to ensure privacy.20

Medical abortion… can be administered and managed by nurses, midwives, and other trained personnel. Trained midlevel providers can safely and effectively perform vacuum aspiration, the standard treatment for failed medical abortions, thus enabling delivery of medical abortion in decentralized areas that have few or no doctors.21

Vacuum aspiration to evacuate a failed pregnancy in the first trimester is performed in a fashion similar to first-trimester pregnancy termination.22

D&E for the indication of fetal demise is performed in the same way as D&E for second-trimester pregnancy termination.23

The above statements from the NAF make an abundance of things clear. First, the relative safety of abortion for the mother depends more on equipment and technique than it does on legality. Second, the future of illegal abortion is not surgical but medical. Women won't be bleeding in the back alley from a punctured uterus. Third, since surgical abortions are performed with the same equipment that is often used to treat spontaneous fetal demise, physicians willing to perform illegal abortions will already have the necessary tools on hand. There is no reason to believe that illegal abortion will be significantly more dangerous for the mother than legal abortion. In the end, the back-alley, coat hanger abortion is nothing more than a convenient myth aimed at sparking emotions and arousing public sympathy. If abortion is outlawed in the future, some abortions will still take place, but relatively few will be fatal to the mother. If abortion remains legal, however, millions of innocent human beings will continue to die–a trade-off that is both tragic and unjust.